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Answering your questions about methadone

Doctor handing a patient a dose of methadone

By CARF International

To help reduce stigma related to the use of methadone in an Opioid Treatment Program (OTP), CARF recently published an article discussing the need to change the conversation about methadone.

To change the conversation, however, there is a need for better public understanding of what methadone is and how it is used as a part of comprehensive treatment for opioid use disorder (OUD).

Many people continue to have concerns that using methadone, which is itself a type of opioid medication, to treat OUD means that methadone treatment involves simply switching one drug for another. Knowing more about how methadone is different from other prescription opioid medications, such as oxycodone and morphine, as well as different from illegal opioids such as heroin, will help to answer these concerns.

Here are some answers to frequently asked questions to promote clarity and understanding.

Q: Is methadone an opioid?

According to the National Institute on Drug Abuse, “Methadone is a long-acting synthetic opioid agonist medication that can prevent withdrawal symptoms and reduce craving in opioid-addicted individuals. It can also block the effects of illicit opioids. It has a long history of use in treatment of opioid dependence in adults and is taken orally.”

Although this definition may sound overly technical, key points to remember are that:

  • As an opioid agonist, methadone attaches to the opioid receptors in the body and brain, which can prevent withdrawal symptoms for many patients.
     
  • As a synthetic opioid, methadone is designed so that carefully prescribed and monitored doses do not produce the “high” or sense of euphoria that other opioids do. This allows patients using methadone as part of their ongoing treatment to drive, work, and participate in life activities. It is legal to drive while using methadone because it does not cause impairment as long as it is taken as prescribed and not mixed with other substances.

Key to remember: OTPs are required to conduct regular drug screenings for all patients to help ensure that methadone is being taken as prescribed and to test for the presence of other substances such as benzodiazepines (Valium, Xanax, etc.) that can be dangerous when taken with methadone.

 

Q: What is methadone used for?

Please note: The scope of this article is limited to the use of methadone as a treatment for OUD.

The U.S. Substance Abuse and Mental Health Services Administration ( SAMHSA) explains that methadone is a medication used in medication-assisted treatment to help people reduce or quit their use of heroin or other opioids. Methadone is used only as one component of a larger treatment plan“Methadone has been used for decades to treat people who are addicted to heroin and narcotic pain medicines. When taken as prescribed, it is safe and effective. It allows people to recover from their addiction and to reclaim active and meaningful lives. For optimal results, patients should also participate in a comprehensive medication-assisted treatment (MAT) program that includes counseling and social support.”

Methadone is used to manage physical withdrawal symptoms, help reduce cravings, and allow patients to participate more fully in their lives and communities while working to achieve and maintain recovery. Methadone doses are individualized to the patient and are adjusted as needed throughout treatment.

Key to remember: Methadone is a safe and effective prescription medication that is used only as one component of a larger recovery plan.

 

Q: How does methadone work?

As defined by SAMHSA, “Methadone works by changing how the brain and nervous system respond to pain. It lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone.”

“As with all  medications used in medication-assisted treatment (MAT), methadone is to be prescribed as part of a comprehensive treatment plan that includes counseling and participation in social support programs.”

Key to remember: Methadone is used to manage withdrawal symptoms when a person stops using other opioid drugs. This can help a person stabilize and work to address their overall individual needs and behavioral or mental health issues, such as work, family life, and counseling.

 

Q: Are there long-term health effects of methadone?

Methadone is the most studied and widely used medication for treatment of OUD, and it has a track record of more than 50 years. Although methadone does have risks and potential side effects, it is a proven safe and effective medication that is approved by the FDA and SAMHSA for long-term use for patients with OUD.

As part of a long-term program, methadone has been shown to reduce mortality, improve overall health, and reduce the risk of HIV infection and criminal behavior.Many of the reported or perceived side effects experienced by some patients while using methadone likely are not caused by methadone. For example, patients have reported health conditions (such as pain, dental problems, loss of bone density, etc.) after beginning treatment.

There are no clinical studies to support the idea that methadone causes these conditions. Often, patients entering treatment for OUD have been using illicit opioids for a long time, and many have existing health conditions or issues that have been undiagnosed. These may surface as the person begins to stabilize during treatment. This can lead to the perception that methadone is the cause.

On the contrary, studies have shown that ongoing methadone use as part of a long-term, comprehensive treatment program can reduce mortality, improve overall physical and mental health, and reduce the risk of HIV infection and criminal behavior. ( SAMHSA TIP 63: Medications for opioid use disorder—Part 3)

Key to remember: Methadone has a long track record and is considered safe and effective when used appropriately. Long-term use is beneficial for many patients, while stopping methadone maintenance treatment often leads to negative outcomes.

 

Q: Can any doctor prescribe methadone?

No. In the United States, the only setting in which methadone can be prescribed to treat opioid use disorder is an OTP.

Clinician counsling a patient
For optimal results with methadone, patients should also participate in a comprehensive medication-assisted treatment program that includes counseling and social support.

OTPs provide a comprehensive approach to recovery, including individual or group counseling, and help with accessing community services. Many OTPs also offer integrated primary care, support for other chronic medical and psychiatric needs, and family supports.

These programs must be certified by the  Center for Substance Abuse Treatment (CSAT), a division of SAMHSA. To achieve certification, OTPs must meet strict guidelines and must be accredited by an approved accrediting body, of which CARF is one. CARF accredits more OTPs than any other accreditor.

OTPs also must be licensed by the Drug Enforcement Administration (DEA), and they receive unannounced site visits from the DEA to monitor compliance with regulations and mandated procedures.

A physician who is the medical director of an OTP must meet specific requirements related to licensing, expertise, and experience. These requirements are set by SAMHSA and supplemented by expectations specific to the accrediting body that accredits the OTP. Many states also have additional state-specific requirements for a physician to be qualified to direct an OTP clinic.

Key to remember: Methadone can be prescribed as part of treatment for opioid use disorder only through a licensed and accredited OTP where it is carefully monitored and used as part of a comprehensive treatment plan.

 

Q: Does methadone cure opioid addiction?

No. Methadone can be an important component in a person’s recovery, but it is not a “cure” for opioid addiction.

Substance use disorders are chronic illnesses that often must be approached with a comprehensive, holistic plan that includes counseling, education, and support services. Methadone is used as part of that plan to manage physical withdrawal symptoms and help reduce cravings.

According to SAMHSA, “Numerous clinical trials and meta-analyses have shown that methadone treatment is associated with significantly higher rates of treatment retention and lower rates of illicit opioid use compared with placebo and with no treatment.”

Key to remember: Methadone is one piece of an ongoing and comprehensive recovery plan for opioid addiction.

 

Q: How long should people be on methadone?

Many people assume that methadone treatment should be short-term. However, patients who remain in treatment and continue the use of methadone as prescribed statistically have better outcomes than those who do not.

The length of time methadone is needed depends on the person, and some individuals need to continue methadone treatment throughout their lives. Stopping methadone treatment has several risks, including a high risk of relapse to illicit opioid use and a high risk of overdose if relapse occurs.

It is legal to drive while using methadone as prescribedStopping methadone also increases risk of a return to criminal or other dangerous behaviors and often leads to the loss of stability gained from ongoing treatment and supports.

Some patients are able to safely reduce or end methadone use over time, but this is not the primary goal of treatment. Instead, progress and success in an OTP are measured by factors such as employment, family engagement, and lack of illicit drug use or criminal behaviors.

Parent and children on a playground
Progress and success in an OTP are measured by factors such as employment, family engagement, and lack of illicit drug use or criminal behaviors.

The need for long-term methadone treatment was recently recognized by the federal government when Congress passed the  SUPPORT for Patients and Communities Act, which made significant changes related to multiple aspects of opioid use, misuse, and addiction in the United States.

One important element of the new law is that it expands Medicare coverage to include OTPs. Medicare historically has not covered OUD treatment, so this change will allow patients to enter or remain in treatment after they become eligible for Medicare at age 65.

Key to remember: OUD is a chronic illness that requires long-term treatment, often for life. Clinical data show overall better outcomes for patients who remain on methadone maintenance treatment than for those who stop taking methadone.

 

Learn more about opioid treatment and recovery.

3/7/2019
(Opioid Treatment and Recovery)


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Hi, Amy. Thanks for reading the blog and taking the time to contact CARF. Because CARF is an accreditor of programs, and we do not provide treatment directly, we can't speak to dosing for an individual. The best person to ask those questions would be your prescribing physician.

Posted by: CARF International at 8/16/2019 8:09:19 AM



I just wanted to ask a question about methadone, I am beginning it in 2 days and I'm very concerned because I've been told that it takes months to get to a dose that will be effective all day and night. My concern is how is the methadone ever going to work if I'm needing to use to daily to keep well, and I'm being raised so slowly , how am I ever going to be able to allow the methadone to work? And why not start us off at a dose right away that will hold us all day? I don't expect to get a reply but if you happen to I would be very grateful for some insight and maybe tips on how to get thru that time to allow it to work. Thank you

Posted by: Amy at 8/16/2019 12:57:38 AM



Thank you for reading the CARF blog and for commenting and sharing your experience, Clifford. This particular article relates to the effectiveness and evidence base of methadone as a treatment for opioid use disorder. The use of methadone in an Opioid Treatment Program is restricted to the treatment of opioid use disorder, so we cannot comment on the use of methadone in treating persistent pain. CARF does have standards for interdisciplinary pain programs, and you may find our latest blog post on community integrated pain rehab of interest: http://carf.org/community-pain-program/.

Posted by: CARF International at 6/17/2019 3:32:13 PM



I’m on a Regimen of 10mg Oxycodone 4 times a day with 5mg of Methadone 3 times a day. I started weaning myself off the Methadone a month ago and am now at 1/2 of a 5mg Methadone 2 times a day. It’s hard to tell if I’m suffering any side affects being I am dealing with many other physical anomaly’s. 3rd Stage Stomach Cancer resulting in the removal of my entire stomach. Fibromyalgia, Peripheral Neuropathy, Spinal Fusion T8-S1 and Cervical Fusion C5/6 C6/7 with pain resulting from those. Basically I’ve adapted to chronic Pain over the past 45 years. I’ve not known a pain free week in 45 years.

Posted by: CLIFFORD MILLS at 6/17/2019 3:12:00 PM



Great article everything was 100% true an i wish more people could learn this themselves and most importantly believe it. People tend to believe negative stereotypes in comparison to the facts provided by years of study.

Posted by: Austin at 3/12/2019 5:17:25 PM

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